• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.1
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• pp.30-35
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• 2011

Introduction: Dental implants are used routinely with high success rates in generally healthy individuals. By contrast, their use in patients with diabetes mellitus is controversial because altered bone healing around implants has been reported. This study examined the bone healing response around titanium implants placed immediately in rats with controlled and uncontrolled diabetes. Materials and Methods: Twenty rats were divided into the control, insulin-treated and diabetic groups. The rats received streptozotocin (60 mg/kg) to induce diabetes; animals in the insulin-treated group also received three units of subcutaneous slow-release insulin. A titanium implant ($1.2{\times}3\;mm$) was placed in the extraction socket of the maxillary first molar and bone block was harvested at 1, 2 and 4 weeks. Results: Bone formation around the implants was consistently (from 1 to 4 week post-implantation) slower for the diabetic group than the control and insulin-treated group. Bone morphogenesis in the diabetic rats was characterized by fragmented bone tissues and extensive soft tissue intervention. Conclusion: The immediate placement of titanium implants in the maxilla of diabetic rats led to an unwanted bone healing response. These results suggest that immediate implant insertion in patients with poorly controlled diabetes might be contraindicated.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.42 no.3
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• pp.139-143
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• 2016

Objectives: If teeth are missing, super-eruption of teeth in the opposing arch can occur in the area and can change the occlusal plane. When missing teeth are replaced with implants, the oral surgeon must determine whether or not the super-erupted teeth need to be treated in order to normalize the occlusal plane. In this study, we evaluated the clinical prognosis of dentition after implant placement and prosthetic treatment were completed in an occlusal plane altered by super-erupted teeth in the opposing arch without additional treatment of the super-erupted teeth. Materials and Methods: Twenty-two patients (9 males, 13 females) were treated with implants and prosthetics without addressing the super-erupted opposing dentition from April 2004 to August 2012 at Seoul National University Bundang Hospital. A total of 33 implants were placed. Values of crestal bone loss, survival rates, and surgical and prosthetic complications for an average of 29.6 months after prosthetic loading were recorded. Results: In one case, the cover screw was exposed after implant surgery. The mean crestal bone loss was $0.09{\pm}0.30mm$. Of the 33 implants, 31 survived, a survival rate of 93.94%. A prosthetic complication occurred in one case but functioned well after correction. Conclusion: Favorable clinical results from prosthetic complications, crestal bone loss, and implant survival rates were exhibited in implants next to a super-erupted opposing tooth.

• Journal of Periodontal and Implant Science
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• v.40 no.2
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• pp.76-85
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• 2010

Purpose: This study aimed to evaluate the effectiveness of the modified sinus floor elevation technique described hereafter as a "hybrid technique," in 11 patients with severely resorbed posterior maxillae. Methods: Eleven patients who received 22 implants in the maxillary premolar and molar areas by the hybrid technique were enrolled in this study. A slot-shaped osteotomy for access was prepared on the lateral wall along the lower border of the sinus floor. The Schneiderian membrane was fully reflected through the lateral slot. Following drilling with the membrane protected by a periosteal elevator, the bone was grafted. All implants were placed simultaneously with sinus augmentation. The cumulative success rate was calculated and clinical parameters were recorded. Radiographic measurements were performed. Results: All implants were well maintained at last follow up (cumulative success rate=100%). The mean residual bone height, augmented bone height, crown-to-implant ratio, and marginal bone loss were $4.1{\pm}1.64mm$, $8.76{\pm}1.77mm$, $1.21{\pm}0.34mm$, and $0.34{\pm}0.72mm$, respectively. Conclusions: Simultaneous implant placement with sinus augmentation by hybrid technique showed successful clinical results over a 2-year observation period and may be a reliable modality for reconstruction of a severely resorbed posterior maxilla.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.6
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• pp.554-560
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• 2008

In posterior maxilla, it is difficult to achieve primary stability of implants due to sinus pneumatization, alveolar bone loss, and low bone quality. The accurate and objective primary stability assessment is important for good prognosis of implants. Purpose: The aim of this study was to assess the primary stability of the non-submerged, internal type implants with maxillary sinus augmentation using deproteinized bovine bone mineral by a resonance frequency analyzer, when residual alveolar bone height is under 8mm Materials and methods: A total of 20 implants was placed into 5 grafted maxillary sinuses in 5 patients. Deproteinized bovine bone mineral (Bio-$Oss^{(R)}$) was used as graft material. SS II implants (diameter 4.1mm, and length 11.5mm, SLA suface)) were placed. All of the patients received maxillary sinus graft procedure by 1-step technique. Residual bone height was $1.3{\sim}7.8mm$ (mean 4.4mm) measured by panorama radiography. After implant placement, RFA was measured at 4,8,12,20 weeks. The results were divided into 2 groups; RFA value under 4mm and over 5mm of bone height. It was statistically analyzed. Results: 1. The primary stability of implants was increased with time 2. The RFA value was above 65 ISQ at 12 weeks 3. There was no correlation between RFA and residual alveolar bone height in maxillary sinus augmentation by 1-step technique. Conclusion: 1-step surgical procedure is a feasible option for patients with as little as 4mm residual alveolar bone height, when utilizing non-submerged, internal type implants with xenografts.

• Journal of Periodontal and Implant Science
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• v.40 no.5
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• pp.244-248
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• 2010

Purpose: The purpose of this study was to radiographically evaluate marginal bony changes in relation to different vertical positions of dental implants. Methods: Two hundred implants placed in 107 patients were examined. The implants were classified by the vertical positions of the fixture-abutment connection (microgap): 'bone level,' 'above bone level,' or 'below bone level.' Marginal bone levels were examined in the radiographs taken immediately after fixture insertion, immediately after second-stage surgery, 6 months after prosthesis insertion, and 1 year after prosthesis insertion. Radiographic evaluation was carried out by measuring the distance between the microgap and the most coronal bone-to-implant contact (BIC). Results: Immediately after fixture insertion, the distance between the microgap and most coronal BIC was $0.06{\pm}0.68\;mm$; at second surgery, $0.43{\pm}0.83\;mm$; 6 months after loading, $1.36{\pm}0.56\;mm$; and 1 year after loading, $1.53{\pm}0.51\;mm$ ($mean{\pm}SD$). All bony changes were statistically significant but the difference between the second surgery and the 6-month loading was greater than between other periods. In the 'below bone level' group, the marginal bony change between fixture insertion and 1 year after loading was about 2.25 mm, and in the 'bone level' group, 1.47 mm, and in 'above bone level' group, 0.89 mm. Therefore, the marginal bony change was smaller than other groups in the 'above bone level' group and larger than other groups in the 'below bone level' group. Conclusions: Our results demonstrated that marginal bony changes occur during the early phase of healing after implant placement. These changes are dependent on the vertical positions of implants.

• Journal of Dental Rehabilitation and Applied Science
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• v.24 no.4
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• pp.381-388
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• 2008

Various techniques and diversely designed implants have been developed to overcome anatomic limitations of the maxillary posterior alveolar bone. The OSFE (osteotome sinus floor elevation) technique has been used for maxillary sinus augmentation. Also, $Endopore^{(R)}$ implant was designed to increase the surface area by its sintered porous surface. The purpose of this study was to evaluate the survival rate of $Endopore^{(R)}$ implants placed in the posterior maxilla in association with the elevation of the sinus membrane using OSFE technique, and examine the new bone formation in the sinus. One hundred fifteen $Endopore^{(R)}$ implants in 66 patients were placed in the posterior maxilla by OSFE technique. The implants were clinically and radiographically followed up for an average of 26.3 months. Most implants were stable and radiographs showed that the bone regenerated in contact with the implants. But, 5 implants in 4 patients were removed after the prosthetic restoration and the survival rate was 95.6% during the follow-up period. The height of new bone formed in the sinus was $3.26{\pm}1.04mm$.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.2
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• pp.69-74
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• 2012

Background: The purpose of this study is to investigate the efficacy and safety of the sedation technique for implant surgery by combining the use of inhalation of nitrous oxide/oxygen with intravenous midazolam. Methods: Patients requiring surgery for the placement of dental implants were randomly allocated to two groups receiving intravenous midazolam or a combined technique using nitrous oxide/oxide and intravenous midazolam. Safety parameters, cooperation scores, anxiety scales, total amount of midazolam administered and recovery time were recorded and compared. Results: There were a statistically significant reduction in the amount of midazolam required to achieve optimal sedation (P<0.01), an overall significant reduction in recovery time (P<0.01), a significant reduction in anxiety scales (P<0.05), and a significant improvement in cooperation (P<0.05) and peripheral oxygen saturation (P<0.05) when a combined technique of inhalational $N_2O/O_2$ and midazolam was used. Conclusions: For implant surgery, this combining sedation technique could be safe and reliable, demonstrating reduction of total dose of midazolam and level of patient's anxiety and improvement in patient's recovery and cooperation.

• Journal of Periodontal and Implant Science
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• v.50 no.6
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• pp.418-434
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• 2020

Purpose: The purpose of the present study was to evaluate the effect of silica-calcium phosphate composite (SCPC) granules on bone regeneration in extraction sockets. Methods: Ten patients were selected for a split-model study. In each patient, bone healing in SCPC-grafted and control ungrafted sockets was analyzed through clinical, radiographic, histomorphometric, and immunohistochemical assessments 6 months postoperatively. Results: A radiographic assessment using cone-beam computed tomography showed minimal ridge dimension changes in SCPC-grafted sockets, with 0.39 mm and 1.79 mm decreases in height and width, respectively. Core bone biopsy samples were obtained 6 months post-extraction during implant placement and analyzed. The average percent areas occupied by mature bone, woven bone, and remnant particles in the SCPC-grafted sockets were 41.3%±12%, 20.1%±9.5%, and 5.3%±4.4%, respectively. The percent areas of mature bone and woven bone formed in the control ungrafted sockets at the same time point were 31%±14% and 24.1%±9.4%, respectively. Histochemical and immunohistochemical analyses showed dense mineralized bundles of type I collagen with high osteopontin expression intensity in the grafted sockets. The newly formed bone was well vascularized, with numerous active osteoblasts, Haversian systems, and osteocytes indicating maturation. In contrast, the new bone in the control ungrafted sockets was immature, rich in type III collagen, and had a low osteocyte density. Conclusions: The resorption of SCPC granules in 6 months was coordinated with better new bone formation than was observed in untreated sockets. SCPC is a resorbable bone graft material that enhances bone formation and maturation through its stimulatory effect on bone cell function.

• Journal of Periodontal and Implant Science
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• v.49 no.1
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• pp.47-57
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• 2019

Purpose: This study was designed to observe the resorption pattern of biphasic calcium phosphate (BCP) used for maxillary sinus augmentation over a 3- to 6-year healing period, and to investigate factors affecting the resorption of BCP. Methods: A total of 47 implants placed in 27 sinuses of 22 patients were investigated. All patients had residual bone height less than 5 mm at baseline. The modified Caldwell-Luc approach was used to elevate the maxillary sinus membrane, and the sinus cavity was filled with BCP (70% hydroxyapatite and 30% ${\beta}$-tricalcium phosphate). Implant placement was done simultaneously or in a staged manner. Serial radiographic analysis was performed up to 6 years postoperatively. Results: During the follow-up period, no implant loss was reported. The mean reduced height of the augmented sinus (RHO) was $0.27{\pm}1.08mm$ at 36 months, and $0.89{\pm}1.39mm$ at 72 months postoperatively. Large amounts of graft material (P=0.021) and a long healing period (P=0.035) significantly influenced the amount of RHO. In particular, there was a significant relationship between a healing period longer than 40 months and RHO. Conclusions: BCP can achieve proper dimensional stability with minimal reduction of the graft height in a 3- to 6-year healing period after maxillary sinus augmentation. The healing period and the amount of graft material influenced the resorption of BCP.

• The Journal of Korean Academy of Prosthodontics
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• v.59 no.1
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• pp.63-70
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• 2021

Using computer-aided design and manufacturing technique improve quality of treatment in many aspect. This case reports the complete mouth rehabilitation of a patient with amelogenesis imperfecta utilizing digital technology. Clinical examination revealed loss of mastication due to insufficient occlusal stop, missing teeth, interdental spacing due to microdontia, insufficient overbite, and etc. Full veneer crowns for teeth were selected, followed by a fixed partial denture and implant placement was done using CAD-CAM guide template with bone graft for partially edentulous space. Definitive restorations were duplicated by double scanning provisional restorations and successfully delivered to the patient. These full mouth rehabilitation procedures resulted in satisfactory outcomes for the patient functionally and aesthetically.